Newlands Clinic, Harare, Zimbabwe.
BMC Infect Dis. 2019 Aug 13;19(1):715. doi: 10.1186/s12879-019-4332-5.
Gynecomastia is known to occur in some men taking an efavirenz-based antiretroviral therapy (ART) regimen. However, the incidence and outcomes of gynecomastia are not known in Zimbabwe. We described the characteristics and outcomes of gynecomastia among male patients on an efavirenz-based ART regimen.
We conducted a retrospective cohort review of data of all male patients aged ≥18 years taking an efavirenz-based regimen at Newlands Clinic, Harare, Zimbabwe before 31 March 2017. The primary outcome was gynecomastia as defined by breast/nipple enlargement reported by patient and confirmed by clinical palpation. Routinely collected data on demographics, baseline CD4, body mass index, duration on efavirenz, clinical presentation and outcomes were extracted from the clinic database and analysed using STATA 12.1. We investigated for any associations with concomitant medicines using cox regression.
We analysed data for 1432 men with a median age of 40 years (IQR: 33-48). Half of the patients were in WHO stage 1 at ART commencement. Median body mass index and CD4 count at efavirenz commencement was 21 (IQR: 19-23) and 260 cells/mm (IQR: 126-412) respectively. The incidence of gynecomastia was 22/1000 person-years (IQR: 17.3-27.8). Over half of the cases (58%) were bilateral and 75% of all cases developed within two years of starting efavirenz. There were no significant associations with concomitant use of isoniazid (HR: 0.95, p = 0.87) or amlodipine (HR: 0.43, p = 0.24). Gynecomastia resolved in 83.5% of cases following withdrawal of efavirenz with a median time to resolution of 3 months (IQR: 2-9).
The incidence of gynecomastia among patients taking efavirenz-based ART was low with most cases developing early on during treatment. Most cases resolved completely after withdrawing efavirenz.
已知某些接受依非韦伦为基础的抗逆转录病毒疗法（ART）方案的男性会出现男性乳房发育。然而，在津巴布韦，男性乳房发育的发生率和结局尚不清楚。我们描述了依非韦伦为基础的 ART 方案中男性患者的男性乳房发育的特征和结局。
我们对 2017 年 3 月 31 日前在哈拉雷纽兰兹诊所接受依非韦伦为基础方案治疗的年龄≥18 岁的所有男性患者的数据进行了回顾性队列研究。主要结局是通过患者报告并通过临床触诊证实的乳房/乳头增大定义的男性乳房发育。从诊所数据库中提取人口统计学、基线 CD4、体重指数、依非韦伦治疗时间、临床表现和结局等常规收集的数据，并使用 STATA 12.1 进行分析。我们使用 Cox 回归分析了与伴随药物的任何关联。
我们分析了 1432 名男性患者的数据，中位年龄为 40 岁（IQR：33-48）。一半的患者在开始 ART 时处于世卫组织 1 期。依非韦伦开始时的中位体重指数和 CD4 计数分别为 21（IQR：19-23）和 260 个细胞/mm（IQR：126-412）。男性乳房发育的发生率为 22/1000 人年（IQR：17.3-27.8）。超过一半的病例（58%）为双侧，所有病例中有 75%在开始使用依非韦伦的两年内发生。与同时使用异烟肼（HR：0.95，p=0.87）或氨氯地平（HR：0.43，p=0.24）无显著关联。在停用依非韦伦后，83.5%的病例男性乳房发育得到缓解，中位缓解时间为 3 个月（IQR：2-9）。
接受依非韦伦为基础的 ART 方案的患者中，男性乳房发育的发生率较低，大多数病例在治疗早期就出现。大多数病例在停用依非韦伦后完全缓解。
